Contemporary dietary guidance recommends healthy dietary patterns with emphasis on food-based recommendations because the totality of the diet (i.e., the combinations and quantities of foods and nutrients consumed) is an important determinant of health. In many guidelines, recommendations are still made for saturated fat, added sugar, sodium, and dietary cholesterol because these are over-consumed by many people and are related to chronic disease development. Epidemiological research illustrates the importance of considering the total diet and the interrelatedness of nutrients in a dietary pattern. Traditionally, epidemiological research focused on individual nutrients in isolation, which can result in erroneous conclusions. An example of this, which has led to substantial controversy, is the evidence from studies evaluating the association between saturated fat and CVD without considering the replacement nutrient. Another controversial topic is the relationship between dietary cholesterol and CVD, which is confounded by saturated fat intake. Finally, the totality of evidence shows that high sodium intake is associated with greater CVD risk; however, some epidemiological research has suggested that a low-sodium intake is detrimental, which has caused some controversy. Overall, this reductionist approach has led to a debate about recommendations for saturated fat, cholesterol, and sodium. However, if approaches that accounted for the interrelatedness of nutrients had been taken, it is likely that there would be less controversy about these nutrients. To encourage dietary pattern-based approaches and consideration of total intake, dietary guidelines should emphasize food-based recommendations that meet nutrient targets. Thus, nutrient targets should underpin food-based dietary guidelines, and recommended dietary patterns should comply with nutrient-based targets. The evidence reviewed shows that it is imperative to consider total dietary patterns for CVD prevention. Dietary guidance should be aligned with nutrient targets and recommendations should be food and dietary pattern based.
Background: Legumes are an inexpensive, healthy source of protein, fiber, and micronutrients, have low greenhouse gas and water footprints, and enrich soil through nitrogen fixation. Although higher legume consumption is recommended under US dietary guidelines, legumes currently comprise only a minor part of the US diet.Objectives: To characterize the types of legumes most commonly purchased by US consumers and patterns of legume purchases by state and region, seasonality of legume purchases, and to characterize adults that have a higher intake of legumes.Methods: We examined grocery market, chain supermarket, big box and club stores, Walmart, military commissary, and dollar store retail scanner data from Nielsen collected 2017–2019 and dietary intake from the National Health and Nutrition Examination Survey (NHANES), 2017–2018.Results: The five leading types of legumes purchased in the US were pinto bean, black bean, kidney bean, lima bean, and chickpea. The mean annual per capita expenditure on legumes based on grocery purchases was $4.76 during 2017–2019. The annual per capita expenditure on legumes varied greatly by state with highest expenditure in Louisiana, South Carolina, Florida, Alabama, Mississippi, and lowest expenditure in Washington, New York, and Wisconsin. There were large regional differences in the most commonly purchased legumes. Of 4,741 adults who participated in the 24-h dietary recall in NHANES, 2017–2018, 20.5% reported eating any legumes in the previous 24 h. Those who consumed legumes were more likely to be Hispanic, with a higher education level, with a larger household size (all P < 0.05), but were not different by age, gender, or income level compared to those who did not consume legumes.Conclusion: Although legumes are inexpensive, healthy, and a sustainable source of protein, per capita legume intake remains low in the US and below US dietary guidelines. Further insight is needed into barriers to legume consumption in the US.
Fruit intake is associated with lower risk of cardiometabolic diseases. However, effects of dried fruits on cardiometabolic health are not well researched. We investigated the effect of daily dried fruit consumption compared with a carbohydrate-rich snack on cardiometabolic disease risk factors in adults with increased cardiometabolic risk. A two-period randomised crossover trial was conducted in adults (n 55) with elevated BMI and at least one additional risk factor for cardiometabolic disease to compare the effects of consuming 3/4 cup/d mixed dried fruits (plums, figs, dates and raisins) or an energy- and carbohydrate-matched control snack for 4 weeks. The primary outcome was LDL-cholesterol; secondary outcomes included other lipids and lipoproteins, glucose and insulin, C-reactive protein, blood pressure and vascular stiffness. Linear mixed models were used for data analysis. Lipid and lipoprotein concentrations did not differ between conditions; however, dried fruit increased LDL-cholesterol (0·10 mmol/l, 95 % CI 0·01, 0·20) compared with baseline. Compared with the control, dried fruit increased mean fasting glucose (0·08 mmol/l, 95 % CI 0·005, 0·16; P = 0·038). Vascular outcomes, fasting insulin and C-reactive protein did not differ between conditions. Mean weight changes did not differ (P = 0·55) but tended to increase after both conditions (dried fruit 0·3 kg, 95 % CI –0·09, 0·65; control 0·4 kg, 95 % CI 0·01, 0·75). Thus, short-term daily consumption of a large portion of mixed dried plums, figs, dates and raisins, without structured dietary guidance, did not improve cardiometabolic risk factors, compared with carbohydrate-rich snacks, in adults with increased baseline cardiometabolic risk.
Background The increased use of high-oleic oils to replace trans fat has led to concern about declining intake of polyunsaturated fat (PUFA) and the potential for essential fatty acid insufficiency or even deficiency. Objective The aim was to examine circulating levels of essential and poorly biosynthesized fatty acids, as biomarkers of dietary intake, in the National Health and Nutrition Examination Survey (NHANES) datasets prior to (2003–04 cycle) and following (2011–12 cycle) legislation to reduce trans fat in the food supply and, additionally, to explore the associations between these fatty acids and markers of cardiometabolic health. Methods Fasting circulating levels of fatty acids from adults (≥ 20 years) in the 2003–04 and 2011–12 NHANES cycles were used for analysis. One day of dietary data from the 2003–04 and 2011–12 cycles were used to examine differences in dietary fatty acid intake between these cycles. Regression analyses were used to assess relationships between circulating levels of fatty acids and cardiometabolic health. Results Between 2003–04 and 2011–12, circulating levels of linoleic acid (LA) increased (1.38%; P = 0.002); no difference in dietary intake was observed. Alpha-linolenic acid (ALA), measured by dietary intake (0.14 g; P < 0.001) and circulating levels (0.23%; P < 0.01), increased from 2003–04 to 2011–12. Circulating LA was inversely associated with BMI (regression coefficient per percentage point change in LA ± SE: -0.22 ± 0.04 kg/m2), waist circumference (-0.62 ± 0.09 cm), systolic blood pressure (-0.38 ± 0.09 mm Hg), triglycerides (-9.92 ± 0.63 mg/dl), glucose (-3.34 ± 0.13 mg/dl ), insulin (-0.18 ± 0.05 µU/ml), and HOMA-IR (-0.29 ± 0.05). Conclusions In a nationally representative sample of U.S. adults, no declines in circulating levels of essential fatty acids, LA and ALA, were observed between 2003–04 and 2011–12; a time when high-oleic oils were increasingly used in the food supply. Higher levels of circulating LA were correlated with lower risk of cardiometabolic dysfunction, which underscores the importance of monitoring consumption in the U.S.
Background High quality diets reduce the risk of cardiometabolic and other chronic diseases. The dietary components that distinguish higher from lower quality diets, and their associations with health, have not been fully investigated. Objective This study aimed to assess the component scores that underlie differences in total Healthy Eating Index (HEI)-2015 scores; quantify fatty acid (saturated, monounsaturated, polyunsaturated) intakes that comprise Fatty Acids component scores; and assess associations between component scores and cardiometabolic risk factors. Methods A cross-sectional analysis of data from the National Health and Nutrition Examination Survey (2001–2016) was conducted. Total and component HEI-2015 scores were assessed in adult (≥19 years) participants who provided one 24-hour dietary recall (n = 39,799). Survey-weighted mean component scores by quartile of total HEI-2015 score were determined. Regression analyses were conducted to assess fatty acid intakes across quartiles of Fatty Acids component scores. Separate regression analyses were conducted to assess associations between component scores and cardiometabolic risk factors, after adjusting for demographic characteristics and health behaviors. Results Scores for components related to dietary fat (Fatty Acids, Saturated Fats) and grain quality (Whole Grains, Refined Grains) accounted for the greatest differences in HEI-2015 scores. Higher Fatty Acids scores were primarily comprised of lower saturated and greater polyunsaturated fat intakes. Whole Fruits, and Seafood and Plant Proteins, were most favorably associated with cardiometabolic risk factors including anthropometric measures (P < 0.001), systolic blood pressure (P < 0.01), glycemic markers (Whole Fruit only, P < 0.01), high-density lipoprotein cholesterol and triglycerides (Seafood and Plant Proteins only, P < 0.001). Conclusions Average diet quality in US adults is suboptimal. Higher quality diets are primarily distinguished by the types of fats and grain-based foods that are consumed. Interventions targeting dietary components that are most favorably associated with cardiometabolic risk factors – Whole Fruits, Seafood and Plant Proteins – may have the greatest impact on disease risk.
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